Non-thumb metacarpal fracture (shaft)

From WikEM
Jump to: navigation, search

Background

  • Extensor tendons and the FDS attach to the middle phalanx[1]
  • Commonly will have volar angulation due to interosseous muscles and extensor tendon attachments[1]

Clinical Features

  • TTP along affected metacarpal
  • Flexion at MCP is difficult

Differential Diagnosis

Hand and Finger Fractures

Evaluation

Imaging

  • Hand x-rays
    • Oblique fracture are more prone to shorten and rotate
    • Transverse fracture generally stable (particularly isolated 3rd or 4th MC shaft fracture)

Physical

  • Assess for extensor dysfunction; patient may exhibit "pseudo-clawing" during attempts at finger extension
  • Assess angulation
    • >10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction
  • Assess rotational alignment

Management

  • Ulnar Gutter Splint or Radial Gutter Splint]
  • Acute reduction indicated if there is pseudo-clawing or significant angulation
    • Closed reduction generally corrects angulation but typically does not restore length

Disposition

  • Refer:
    • Malrotation
    • Comminution
    • Shortening > 5mm (refer all shortening if not familiar with fracture management)
    • 2 or more metacarpal fractures
    • Unacceptable angulation
    • Long oblique fractures

See Also

References

  1. ↑ 1.0 1.1 German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.